Musings in the life of an internist, cardiologist and cardiac electrophysiologist.

Sunday, October 31, 2010

The Importance of Our Health Care Myers-Briggs

With all the talk about special interest groups in health care reform, there is another force afoot that is much more influential: psychologic interest groups. Here I take a rough stab of characterizing those I've noticed in our ongoing health care debate:

Insist on fear-based appeasement: if you don't give them what they want, the peasants will come knocking at your door.

Secret elitist belief that I'll get what I want anyway

Infantile inflexibility to alternatives from their beliefs

I'll-hold-my-breath-until-you-cry-uncle form of debate

Discomfort with their own aggression or shadow side

Politically active

Distrustful (D) - "No stick is big enough"

Characteristics of this psychologic construct include:

Aggrieved, victim mentality

Some history of real inequities or being disenfranchised which colors all perceptions

Safety first - no quality control will ever be enough

Doctors are greedy and will work best a pernicious, punitive environment

Group oversight is superior to individual oversight

There can never be enough bean-counters

Politically active - often protest marchers

Alfred E. Neumann (A) - "What Me Worry?"

This group never has health care issues until they do. Characteristics include:

Immature, emotionally unmodulated

Extreme anxiety/neediness in the hospital but complete denial when they hit the exit door.

Discussions of doctor availability are of no relevance until they are pressing the nurse call button

Politically inactive, rarely vote

So, which are you?

To date, many doctors have lived in our own fairy land when it comes to health care policy. We have preferred to insist that human beings will think in a fair-minded, scientific, data-based manner. Who would have known that we should have had a psychology or marketing degree? Perhaps this is why the debate has become so divisive.

Unless we address these powerful, subliminal psychologies head-on, our influence on the larger social policies influencing health care delivery in the future will remain limited.

No, it is nothing like stem cell research. The "issue" with stem cell research is on the source of embryonic stem cells and the fear that allowing embryonic stem cells would lead to a market for them. There are serious ethical issues with that (farming embryos, for example).

In fact, you will find that almost all opposition melts away when you are talking about adult stem cells. Only a handful of kooks get upset about that. Mainstream pro-lifers are actually enthusiastic about adult stem cell research, and ironically, it's been shown to be far more viable.

Dr. Wes,I harness greed and self-interest all the time. Do you think my dentist enjoys cleaning my teeth or lecturing me about flossing? Do the grocery workers get enthusiastic about stocking the foods I buy for what is historically an incredibly low price? Sure, there are people in many professions that do it because they love it, and would continue to work at half their pay, but I'm quite happy to work with the mercenaries, thank you. Beats the devil out of not being able to find someone to assist you when you need it.

I fit most closely on the L type, but I recognize that any system in the real world has to suck for someone. You could easily pour infinite resources into it if you wanted to. So I prefer dollar votes to political ones, and economic allocation to political allocation.

Boy, Dr Wes, have you got libertarianism all wrong. Libertarianism is about:

1. Exalting the right to life, liberty and property, which implies "free market" economics, one supposes, since the alternatives, like socialism, represent theft of liberty and property.

2. Non-aggression.

Not much else. Optimism, faith in human nature, frailty & greed have nothing to do with libertarianism. Libertarianism is not concerned with non-oppressive religion, humanism, or humanitarianism.

A libertarian can be of any religion, materialistic, greedy, selfish, gay, male, female, or not.

What he can't do is support laws regarding victimless crimes, sex in strange positions, theft of the people's wealth to finance education or healthcare or any compulsion that limits liberty or transfers income or wealth.

In particular, libertarians, like Milton Friedman, denounce licensing and certification of physicians, nurses, pharmacists, lawyers, teachers, plumbers, electricians and other monopolists and oligopolists. You need to get out more, read some books, or stick to medicine or something else that you know something about!

Dr. Wes,The fact that it always sucks to be SOMEBODY is an inevitable consequence of the fact that we live in a world with limited resources. That's simply a readily observable result of living in a fallen world when viewed from a Christian point of view. The problem with public discourse is this:

You have a massive disadvantage in rhetorical combat when you admit that your decisions WILL suck for someone, even though that is nearly ALWAYS true. So everyone who wants power or wants power kept away from someone else in the public arena has to pretend that their plans are all sunshine and dancing unicorns. That's the problem. The most successful parties politically are the ones best at laundering their naked group interest through noble-sounding language. Personally, I prefer it when people speak plainly. I don't condemn people for advocating things simply because they're in their own self-interest, I simply object strenuously when they misappropriate moral language towards those ends. The end of the moral language arms race is war, which ends in tears.

I found your Libertarian part to be mostly accurate in the nouns but very innacurate in the adjectives.

-I'm not "sunny optimist" about the free market, I just expect (based on the real data and examples I can find) it to do less badly (in general, on the whole, over time) than all the other options humanity has tried so far.

-My faith in human nature is pretty darn low... which I want as few of them as possible in authority over me (or as many as possible on the committee that has authority over me, that hamstrings them pretty well).

-Competition won't ASSURE price controls (not even close), but it will do a better job than the alternatives

-I don't deny human frailty or greed at all, indeed, I expect them to get in the way all the bloody time

-Cynical about humanitarianism. OK, you got this one.

I don't at all buy into the rosy picture painted by some libertarians about how perfect the libertarian (nigh-anarchic) world would be... it would still produce bad results in a significant number of cases. There would still be theft, murder, etc. But the worst excesses that people complain about are done by people in positions of power, as they are the ones who can get away with it. So... divide that power up as much as possible. Don't like large corporations? How is the government different than a large corporation? They aren't accountable to anyone!

About Me

Westby G. Fisher, MD, FACC is a board certified internist, cardiologist, and cardiac electrophysiologist (doctor specializing in heart rhythm disorders) practicing at NorthShore University HealthSystem in Evanston, IL, USA and is a Clinical Associate Professor of Medicine at University of Chicago's Pritzker School of Medicine. He entered the blog-o-sphere in November, 2005.
DISCLAIMER: The opinions expressed in this blog are strictly the those of the author(s) and should not be construed as the opinion(s) or policy(ies) of NorthShore University HealthSystem, nor recommendations for your care or anyone else's. Please seek professional guidance instead.